BACKGROUND Cognitive decline and dementia risk have been associated with diet, exercise, social interaction, church attendance, alcohol consumption and smoking. OBJECTIVES To identify distinct behavioral patterns, and to examine their association with subsequent dementia risk. DESIGN Longitudinal, population-based dementia study. SETTING Rural county in northern Utah, at-home evaluations. PARTICIPANTS 2,491 non-demented participants (51% male) initially reported no problems in activities of daily living and no stroke or head injury within past five years. Average age was 73.01 (SD=5.69) years and average education 13.67 (SD=4.10) years. MEASUREMENTS Six dichotomized lifestyle behaviors included: Diet: high = above median on the Dietary Approaches to Stop Hypertension scale; Exercise: 5+ hours/week of light activity and at least occasional moderate/vigorous activity; Church attendance: attending church services at least weekly; Social Interaction: spending time with family/friends at least twice weekly; Alcohol: currently drinking alcoholic beverages 2+/week; Non-smoker: no current use (or former if < 100 cigarettes ever). Latent Class Analysis (LCA) identified patterns among these behaviors. Proportional hazards regression modeled time to dementia onset as a function of behavioral class, age, gender, education, APOE status. Follow-up averaged 6.32 (SD=5.31) years, revealing 278 cases of incident dementia (200 AD). RESULTS LCA identified four distinct lifestyle classes. “Unhealthy-Religious” (UH-R; 11.5%), “Unhealthy-Non-Religious” (UH-NR; 10.5%), “Healthy-Moderately Religious” (H-MR; 38.5%), and “Healthy-Very Religious” (H-VR; 39.5%). Compared to UH-R class, UH-NR (Hazard Ratio, HR=.54, p=.028), H-MR (HR=.56, p=.003), and H-VR (HR=.58, p=.005) had significantly lower dementia risk. Results were comparable for AD, except that UH-NR was less definitive. CONCLUSION Functionally independent older adults appear to cluster into subpopulations having distinct patterns of lifestyle behaviors with different levels of risk for subsequent dementia and AD.
This study investigated possible associations between selected polymorphisms in the dopamine receptor genes DRD1 and DRD3 with the presence of psychotic phenomena or aggressive behaviour in a community based cohort of 134 patients with late onset Alzheimer's disease. An association was found between the presence of psychotic symptoms and aggressive behaviour and the DRD1 polymorphism and between the presence of psychosis, but not aggression, and the DRD3 polymorphism. Specifically, carriers of the DRD1 B2 allele were more likely to be aggressive or experience hallucinations whereas homozygous carriers of the DRD3 1 allele were more likely to experience delusions. (J Neurol Neurosurg Psychiatry 2001;71:777-779) Keywords: Alzheimer's disease; genetics; behaviour Cognitive decline is, by definition, invariably present in Alzheimer's disease. However, various other behavioural and psychological symptoms in dementia (BPSD) are also present, with psychotic symptoms found in about a third of cases and aggressive behaviour in around a half. The mechanism by which BPSD occurs in some patients with Alzheimer's disease is not completely understood but we have previously shown that common genetic polymorphisms in the serotonin receptors 5-HT2A and 5-HT2C are associated with the presence of psychotic phenomena, particularly hallucinations, in Alzheimer's disease.1 More recently, a study of the dopamine DRD1, 2, 3, and 4 receptors 2 has suggested an association between common polymorphisms in the DRD1 and DRD3 receptors and the presence of aggression and psychosis in Alzheimer's disease. This study was designed to examine the role that these polymorphisms might have on the development of specific components of psychotic phenomena-namely, the presence of delusions and hallucinations in patients with late onset Alzheimer's disease. Methods PATIENTSPatients were selected from the Camberwell Dementia Case Register. This is a community based register consisting of patients referred to psychiatric, medical, and social services with the districts of East Lambeth and South Southwark (formerly Camberwell), London, from April 1993 to April 1995. All patients were screened using the minimental state examination (MMSE) and any patients scoring less than 24 points were included for further assessment. Of the 528 patients fulfilling these criteria 374 also fulfilled the The patients and the next of kin or main carer were interviewed in all cases by means of the CAMDEX 5 and the presence of a psychiatric history defined according to these guidelines-that is, an emotional or nervous illness requiring treatment. Presence of psychopathology was assessed by the Manchester and Oxford Universities scale for the psychological assessment of dementia (MOUSE-PAD).6 Due to possible ethnic diVerences in the frequencies of DRD1 and DRD3 receptor polymorphisms only white persons were included in this study. SuYcient genetic material was available for DRD3 genotyping in 129 cases and for DRD1 genotyping in 105 cases.Ethical approval was obtain...
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